The Effect of Toilets on Education

Did you know that one of the main barriers to girls getting an education starts in the bathroom?

You read that right. Not a lot of people want to talk about it, but in much of the developing world, one of the top barriers to girls’ education is the lack of safe and separate latrines for girls and boys. In fact, in many areas it’s the number one cause of school absenteeism, ahead of malaria and other diseases. In the United States, being able to find a safe, private bathroom is something that most of us take for granted. But only 45% of schools in the least developed and low-income countries have adequate sanitation facilities.

How does a safe, private toilet influence girls’ education, you ask? Well, first it’s important to note that access to adequate sanitation facilities can influence the education of all children in the developing world. These facilities lead to improved sanitation and hygiene, which in turn, can reduce the number of water-born illnesses and diarrheal episodes that cause  – among other devastating outcomes – school absenteeism. But adolescent girls are at greatest risk for being affected!

When a girl reaches puberty, access to a safe, private toilet can make a crucial difference in whether or not she continues her education. Girls need clean water to wash themselves or their menstrual cloths and a place to dispose of their menstrual pads if they are using them. If girls don’t have access to these facilities at school, they will often stay at home during their monthly periods. In fact, lack of safe, private toilets can cause girls to miss up to 20% of the school year. As one might imagine, irregular attendance can lead to lower grades and may, eventually, lead to dropping out of school altogether.

Also, believe it or not- gender segregated toilets that are located in convenient, safe locations at school can protect girls from violence and assault! Women and girls are often vulnerable to harassment or violence when they have to use shared toilets or are forced to go to the bathroom outside. In one survey of schoolgirls in South Africa, for example, more than 30% reported having been raped at school; often these incidences occurred in school toilets that were either shared or in an unsafe, isolated locations. Such violence is a major deterrent to school attendance, not to mention a girl’s self-esteem and desire to learn.

Finally, when girls don’t have access to a toilet at all, they’re forced to go outside. To retain some sense of privacy (and dignity), many girls will choose to ‘hold it’ or limit their consumption of food and drink to delay the need to relieve themselves. Not only can these actions increase the chance of urinary tract infections, but it also means that girls aren’t eating and drinking as they should, which can lead to dehydration and malnourishment.

In sum, there are already many reasons that put girls in much of the developing world at high risk for either dropping out of school or not going in the first place. But when schools have appropriate sanitation facilities, one of those obstacles is eliminated, and one more girl is empowered to make a difference!


“This is the work that sticks”: Stories from Ecuador

During July and August of 2014, one of Minga’s Board members, Karin Friederic (who is also an Assistant Professor of Anthropology at Wake Forest University), traveled to Minga’s project site in Ecuador with two of her students, Ty Kraniak and Bennett Heine. While Dr. Friederic conducted pilot research for her current project and intervention on family relations and intimate partner violence, Ty investigated the effects of the SaludCom project and Bennett lent his support by improving health center facilities, painting the community library, and developing health education materials. Together they participated in medical brigades with health center staff, took jungle treks, swam in beautiful waterfalls at the Bilsa Biological Station, and they learned survivalist cooking techniques, like making rice in bamboo stalks and plantain patties over open fires. Above all, they partnered with local friends and colleagues to improve community health and healthcare through plenty of hard work and laughter.

Here’s one of Karin’s stories from the field:

The generator kept going out. The lights flickered and the machinery whirred. My student, Ty, stepped in with an array of headlamps and flashlights to help the dentist, Thamar, as she continued to clean teeth and treat cavities with her manual tools. She could still see, thankfully, but with two more patients waiting, this now meant at least another hour of work, not twenty minutes. We couldn’t send the patients home—they lived an hour away and had waited all day to be seen. While important, these rural medical brigades (when health center staff travel to a remote community for 2-3 days to provide medical care and health education) were never quite enough. As workers in global health and development already know, administering health care in rural Ecuador is different than health care in the United States. For one, in the U.S. we can depend on a certain level of basic infrastructure (i.e. stable electricity, newer equipment, paved roads). However, in many parts of the world, people are meeting these challenges by prioritizing particular kinds of infrastructure and technology and adapting them to better serve diverse needs and contexts across the globe.

To this end, in 2010 the Minga Foundation partnered with NOKIA to understand how mobile cell phones could be used to improve health communication and responsiveness to local illnesses and emergencies. For example, rather than installing landline telephones and electricity lines, one community in rural Ecuador utilizes cell phones and solar panels for communication and electricity. However, despite widespread success, every project has its hiccups—a truth that, at the very least, always keeps us on our toes. There aren’t enough cell phone towers to provide consistent coverage to these rural areas, and despite early promises from cell phone operators in Ecuador, they lost interest in the project. So, while our health promoters and health committee members benefitted from having quality cell phones, many still had to walk 30 minutes to the top of a ridge or a particular tree to get cell signal. As a medical anthropologist who helps develop health programming in rural Ecuadorian communities, I am consistently trying to take advantage of technology’s benefits (often touted as the simple answer to under-development), while simultaneously developing flexible and adaptive contingency plans; as we have seen time-and-time again in development projects worldwide and in the United States, tech fixes are never enough.

Thus, as part of the SaludCom Project in Ecuador (2010-2014), we’ve been integrating technology with common-sense and culturally appropriate approaches to communication. We’ve given out cell phones and installed booster antennas, but we’re also using additional less-sexy platforms: printed flyers and face-to-face communication. In this region, people have varying access to technology and they live in remote locations (up to ten hours away from the health center); therefore, it is crucial that people receive messages about health center hours, availability of doctors, medical emergencies, health related meetings, and health promotion activities. NOKIA stepped in wanting to provide a silver bullet that would allow us to skip paper and face-to-face interaction. While that approach may have been more efficient in theory, experience on the ground called for complementary strategies to be effective. Our friends in Ecuador demanded that, and guided us to recognize that. Just as Thamar and Ty adapted to electricity shortages by using alternative tools on hand, Minga has been working in close partnership with community members and continually retooling our strategies to make sure that what we do, we do well, even if it takes us a few extra steps. I repeatedly tell my students that the ideas informing the work of global health and development should never emerge “fully cooked” in board room meetings, annual retreats, or even classrooms. Implementing ideas in deep partnership with communities and in radically distinct contexts can be humbling, frustrating, and slow, but after fourteen years of experience, this is the work that sticks. Please share ideas and experiences if you’d like and, as always, I invite you to Minga with Us.